Provider Demographics
NPI:1063691012
Name:EAST HILL FOOT AND ANKLE CLINIC
Entity type:Organization
Organization Name:EAST HILL FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-859-1112
Mailing Address - Street 1:24837 104TH AVE SE
Mailing Address - Street 2:101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6800
Mailing Address - Country:US
Mailing Address - Phone:253-859-1112
Mailing Address - Fax:253-859-1190
Practice Address - Street 1:24837 104TH AVE SE
Practice Address - Street 2:101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6800
Practice Address - Country:US
Practice Address - Phone:253-859-1112
Practice Address - Fax:253-859-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC600586258213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMXPR0043826OtherMOLINA HEALTHCARE
WA7004971Medicaid
WA0593870001Medicare NSC
WAQMXPR0043826OtherMOLINA HEALTHCARE